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Achilles Insertional Tendinopathy: What you need to know

Achilles tendon insertional tendinopathy is a condition that affects the tendon in the heel and ankle. The Achilles tendon is one of the largest tendons in the body, and connects the calf muscles to the heel bone. It is important for activities that involve walking, running, and jumping.


Symptoms of Achilles tendon insertional tendinopathy include pain and tenderness along the back of the heel and ankle, particularly when walking or running. The pain may also be present when standing on tiptoes or when stretching the calf muscles. In severe cases, the area may be swollen or stiff, and the individual may have difficulty bending or straightening the ankle.


Achilles tendon insertional tendinopathy is typically caused by repeated stress on the Achilles tendon, such as from running or jumping activities. It can also be caused by muscle imbalances or weakness in the surrounding muscles, or by alignment issues with the heel bone.


Preventing Achilles tendon insertional tendinopathy involves taking steps to avoid overusing the Achilles tendon and surrounding muscles. This may include using proper technique when running or jumping, and avoiding activities that put excessive strain on the heel and ankle. It may also involve stretching and strengthening the surrounding muscles to improve their strength and support the Achilles tendon.




What is the role of ultrasound in achilles insertional tendinopathy?

Ultrasound is a diagnostic tool that can be used to evaluate Achilles tendon insertional tendinopathy. It uses high-frequency sound waves to create detailed images of the tendons, muscles, and other structures in the heel and ankle.

Ultrasound is typically performed by a trained healthcare provider, who will use a handheld device to transmit sound waves into the affected area. The sound waves bounce off the tissues in the heel and ankle, and are picked up by the device and converted into images on a computer screen.

The role of ultrasound in Achilles tendon insertional tendinopathy is to provide detailed images of the affected area, which can help the healthcare provider diagnose the condition and plan the appropriate treatment. Ultrasound can show the size and shape of the Achilles tendon, as well as any swelling or inflammation that may be present. It can also show any tears or other damage to the tendon that may be contributing to the symptoms.

In addition to diagnosis, ultrasound can also be used as a treatment tool for Achilles tendon insertional tendinopathy.



What are the treatment options?

Treatment for Achilles tendon insertional tendinopathy typically involves a combination of rest, ice, and pain medication to reduce inflammation and alleviate symptoms. Physical therapy may also be recommended to stretch and strengthen the affected muscles and improve flexibility.

Certain types of ultrasound, such as extracorporeal shock wave therapy, can be used to deliver energy to the affected area and stimulate healing of the tendon.

In severe cases, injection therapy (Steroid, Hyaluronic Acid) may be given to provide more rapid relief. Surgery is reserved for patients who fail to respond to physiotherapy and non-surgical treatment.



What is the role of injections in Achilles insertional tendinopathy?

Injections may be used as a treatment option for Achilles tendon insertional tendinopathy. These injections typically contain a corticosteroid, which is a type of medication that reduces inflammation and pain. The injection is delivered directly into the affected area usually with ultrasound guidance.

Injections are typically used in conjunction with other treatment methods, such as rest, ice, and physical therapy. They may be recommended for individuals with Achilles tendon insertional tendinopathy who are experiencing significant pain and discomfort, and are not responding to other treatment methods.

Steroid Injections are not a long-term solution for Achilles tendon insertional tendinopathy, and should be used in combination with other treatment methods to address the underlying causes of the condition. Overuse of injections can lead to side effects, such as thinning of the skin or infection, so they should be used with caution.

Hyaluronic acid injection is a treatment option for Achilles tendon insertional tendinopathy that may be considered in some cases. Hyaluronic acid is a naturally occurring substance in the body that helps to lubricate and cushion the joints. Injection of this substance into the affected area can provide temporary relief of symptoms by reducing friction and improving the function of the Achilles tendon.

The use of hyaluronic acid injection for Achilles tendon insertional tendinopathy is still being researched, and its effectiveness is not yet fully understood. Some studies have shown that it can provide good relief of symptoms, but its long-term effectiveness is not clear. It is typically used in cases where other treatment methods have not been effective, or in individuals who are unable to undergo surgery. Hyaluronic Acid injections are generally considered to have less side effects when compared to Steroid injections.



Overall, Achilles tendon insertional tendinopathy is a common and treatable condition that can cause significant pain and discomfort. By seeking prompt medical care and taking steps to prevent further strain on the affected tendons, individuals can manage their symptoms and return to their normal activities. If you are experiencing Ankle, Heel or Foot pain, contact ACTIVATE Clinic in Kent or book an appointment online.


About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.

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